Provider Demographics
NPI:1154355873
Name:PARKER, BETSY CHARLOTTE (ARNP)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:CHARLOTTE
Last Name:PARKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 PARK BLVD
Mailing Address - Street 2:OAKHURST MEDICAL CLINIC
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776
Mailing Address - Country:US
Mailing Address - Phone:727-393-3404
Mailing Address - Fax:727-393-4814
Practice Address - Street 1:3800 EAST BAY DR
Practice Address - Street 2:EAST BAY MEDICAL CENTER
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771
Practice Address - Country:US
Practice Address - Phone:727-539-0505
Practice Address - Fax:727-538-0067
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2576892363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
E2785YMedicare ID - Type Unspecified
S84761Medicare UPIN